About 70% of caregivers studied reported that they preferred to use the emergency department for treatment for asthma exacerbations, indicating current education is insufficient for managing asthma at home.
The most significant knowledge gaps identified related to the mechanism of action and appropriate use of rescue and maintenance medications.
Education regarding asthma interventions can lead to decreased morbidity and mortality, reduced admission rates, lower cost, and improved outcomes for a child with chronic asthma, noted the authors.
“Asthma is incredibly common, and although there are numerous treatments available, it still accounts for approximately 200 pediatrics deaths per year in the US,” they wrote, citing CDC research. “Perhaps it is time to go back to the basics and refocus our energies on how to effectively assess for gaps in knowledge, provide essential education using the most effective and efficient delivery methods and evaluate that our patients and their caregivers understand.”
A quality improvement study was conducted to identify some of these specific gaps in knowledge of caregivers of children with asthma.
Participants were asked to complete questionnaires based on 2021 guidelines from the National Institute of Health as well as the Global Initiative for Asthma.
Of the 50 caregivers studied, 70% reported that they preferred to take their child to an emergency department (ED) for treatment during an asthma attack, despite 98% stating that they had a primary caregiver/medical clinic where their child received asthma care.
Only 20% of caregivers classified their child’s asthma as well-controlled.
All of the caregivers reported taking their child to an ED for an asthma exacerbation at least once in the previous 6 months.
The prevalence of ED use suggests poor understanding of home management strategies, supported by the finding that only 27% of caregivers reporting having an asthma control plan for at home management.
However, the majority of the caregivers (80%) reported receiving prior education on the asthma disease process and use of asthma medication from a medical provider.
While caregivers were knowledgeable regarding asthma triggers, the responses showed knowledge gaps regarding the use of albuterol and steroids. Only 57% of caregivers correctly answered questions regarding the mechanism of action of albuterol.
Just 26% correctly answered that inhaled steroids are maintenance medications that should be administered even if the child is not experiencing acute asthma symptoms.
On a better note, 92% of caregivers responded that they do permit physical activity for their children during asymptomatic times, demonstrating participation in age-appropriate physical activities.
However, 48% of parents reported feeling stressed due to their child’s asthma, with only 62% of caregivers reporting that they felt confident caring for their child during an asthma attack.
Overall, the caregivers were found to have a suboptimal understanding of the asthma disease process and home management strategies.
The authors suggest patient education be viewed as a high priority for emergency healthcare providers to achieve quality, safety, and patient satisfaction. But they recognized it is not realistic to consider the delivery of a comprehensive asthma education program for caregivers during ED visits due to time constraints.
“To optimize patient outcomes, it is crucial that emergency healthcare providers maximize windows of opportunity for ‘teachable moments’ and identify the most important specific knowledge gaps a caregiver has to guide the delivery of appropriate education,” they concluded.
The study faced limitations. The population of caregivers studied was a nonrandom convenience sample potentially subject to selection bias. The sample size was smaller than planned due to COVID-19 impacts.
Knowledge assessment tools used were not validated in a pilot study prior to use.
Though the selected setting of a pediatric emergency department included an environment faced with time constraints, high patient volumes, and overextended resources that limit teaching opportunities, the authors assert that the implications of their research can be extended to other clinical pediatric healthcare settings.
Kathleen J, Maren C, James RY, et al. Identification of caregiver's knowledge and perceptions of pediatric asthma management: A quality improvement initiative. J Pediatr Nurs. Published online April 6, 2022. doi:10.1016/j.pedn.2022.03.006